Jin Chunchun, Deng Meifang, Zhang Jing, Lu Jianghao, Hao Yanli
Department of Ultrasound, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China.
Front Oncol. 2024 Nov 27;14:1502878. doi: 10.3389/fonc.2024.1502878. eCollection 2024.
Castleman's disease (CD) represents a rare polyclonal lymphoproliferative disorder characterized by atypical lymph node hyperplasia, the precise etiology of which remains undefined. Pancreatic involvement of CD is particularly uncommon and often misdiagnosed due to its nonspecific clinical features, making it difficult to distinguish from tumors with abundant blood supply such as solid pseudopapillary tumors and neuroendocrine tumors. Multimodal imaging plays a crucial role in diagnosing pancreatic CD and determining the extent of lymph node involvement. Surgical resection is the preferred treatment for unicentric CD (UCD). Regular follow-up and monitoring are essential for optimal patient management and treatment outcomes.
A 26-year-old female presented to our hospital with a pancreatic mass detected during a routine health examination. Physical and laboratory examinations were unremarkable. Conventional ultrasound revealed a hypoechoic, oval-shaped mass measuring approximately 34×31 mm in the pancreatic head, with clear boundaries and heterogeneous internal echoes, but no significant blood flow signals. Contrast-enhanced ultrasound showed hyperenhancement of the pancreatic head mass, raising suspicion for a solid pseudopapillary tumor or other entities. To clarify the diagnosis, Contrast enhanced CT, MRI, and FDG PET-CT were performed. Both Contrast enhanced CT and MRI demonstrated hyperenhancement of the lesion, and PET-CT showed hypermetabolism in the pancreatic head mass, along with multiple enlarged lymph nodes in the abdominal and retroperitoneal regions. These findings suggested a lymph node origin for the pancreatic head mass. Surgical resection was performed, and pathological examination confirmed UCD. The patient has been followed for 44 months without recurrence.
This case illustrates the utility of multimodal imaging in diagnosing pancreatic CD. In cases of benign pancreatic lesions with enlarged abdominal and retroperitoneal lymph nodes, CD should be considered.
卡斯特曼病（CD）是一种罕见的多克隆性淋巴增生性疾病，其特征为非典型淋巴结增生，确切病因尚不清楚。CD累及胰腺极为罕见，且因其非特异性临床特征常被误诊，难以与血供丰富的肿瘤如实性假乳头状肿瘤和神经内分泌肿瘤相鉴别。多模态成像在诊断胰腺CD及确定淋巴结受累范围方面起着关键作用。手术切除是单中心CD（UCD）的首选治疗方法。定期随访和监测对于优化患者管理及治疗效果至关重要。
一名26岁女性因在常规健康检查中发现胰腺肿块前来我院就诊。体格检查和实验室检查均无异常。常规超声显示胰头有一个低回声椭圆形肿块，大小约为34×31mm，边界清晰，内部回声不均匀，但无明显血流信号。超声造影显示胰头肿块呈高增强，怀疑为实性假乳头状肿瘤或其他病变。为明确诊断，进行了增强CT、MRI和FDG PET-CT检查。增强CT和MRI均显示病变呈高增强，PET-CT显示胰头肿块代谢增高，同时腹部和腹膜后区域有多个肿大淋巴结。这些发现提示胰头肿块起源于淋巴结。进行了手术切除，病理检查确诊为UCD。患者已随访44个月，无复发。
本病例说明了多模态成像在诊断胰腺CD中的作用。对于伴有腹部和腹膜后淋巴结肿大的良性胰腺病变，应考虑CD。
